PCP, EPOs, PHD ABD, SSRIs, halp!
April 9, 2013 6:43 PM Subscribe
I am an ABD grad student dealing with significant situational depression. My therapist has recommended I seek out a prescription for an SSRI (antidepressant). My insurance situation is a bit complex -- I'm on the university's faculty EPO plan, but don't have a primary care physician relationship established. Trying to sort out the right order of operations for making sure I get coverage, and get timely access to care.
For the last 5+ years, I have been a grad student, on university funding and using my university's student health insurance, which more or less covers the student health center on campus, and referrals from there to specialists. Last fall, I was hired as a one-year-term contract lecturer in my department, which is technically a faculty position. As a result, I elected to join the university's faculty EPO, which is a "you must go in-network, and you must get a referral from your in-network PCP to make an appointment with a specialist" plan. I've been paying for talk therapy out-of-pocket because my (very good) therapist does not accept insurance. I'm generally fairly healthy and have not yet established a relationship with a PCP, because I knew at the start this would be a time-limited arrangement and I'd be moving on after a year, and have not had any significant medical problems.
Recently, things have been very hard at work, and I've been feeling very depressed. My therapist has suggested that I look into antidepressants, and I agree that this is the right next step for me. My therapist is a Ph.D, not a Psy.D, and so can't proscribe anything. Since she's not in my insurance network, she can't refer me to anyone directly. I don't have a primary care physician. I'm not sure who to contact next. I'm not sure if student health services at my university is in-network for my EPO, and even if they are, I'm not sure how to set up a non-urgent-care type appointment with someone over there. It doesn't seem appropriate to try and convince an urgent care provider, either on campus or off, to proscribe SSRIs (if they even would, which I doubt). I'm not sure who to contact where to untangle this mess, and the utterly lethargic, unmotivated way I'm feeling isn't helping.
I realize nobody here can give me the answers, but who should I be reaching out to in order to get the answers without inadvertently shooting myself in the foot re: coverage/reimbursement? If you've been in a similar situation, how did you resolve it?
I don't want to post my insurance provider or the student health insurance provider to avoid de-anonymizing myself, but if it's important to know I will follow up with the mods.
For the last 5+ years, I have been a grad student, on university funding and using my university's student health insurance, which more or less covers the student health center on campus, and referrals from there to specialists. Last fall, I was hired as a one-year-term contract lecturer in my department, which is technically a faculty position. As a result, I elected to join the university's faculty EPO, which is a "you must go in-network, and you must get a referral from your in-network PCP to make an appointment with a specialist" plan. I've been paying for talk therapy out-of-pocket because my (very good) therapist does not accept insurance. I'm generally fairly healthy and have not yet established a relationship with a PCP, because I knew at the start this would be a time-limited arrangement and I'd be moving on after a year, and have not had any significant medical problems.
Recently, things have been very hard at work, and I've been feeling very depressed. My therapist has suggested that I look into antidepressants, and I agree that this is the right next step for me. My therapist is a Ph.D, not a Psy.D, and so can't proscribe anything. Since she's not in my insurance network, she can't refer me to anyone directly. I don't have a primary care physician. I'm not sure who to contact next. I'm not sure if student health services at my university is in-network for my EPO, and even if they are, I'm not sure how to set up a non-urgent-care type appointment with someone over there. It doesn't seem appropriate to try and convince an urgent care provider, either on campus or off, to proscribe SSRIs (if they even would, which I doubt). I'm not sure who to contact where to untangle this mess, and the utterly lethargic, unmotivated way I'm feeling isn't helping.
I realize nobody here can give me the answers, but who should I be reaching out to in order to get the answers without inadvertently shooting myself in the foot re: coverage/reimbursement? If you've been in a similar situation, how did you resolve it?
I don't want to post my insurance provider or the student health insurance provider to avoid de-anonymizing myself, but if it's important to know I will follow up with the mods.
Yeah, just pick someone from the list of in-network providers that you get a good vibe from and who is easy to get to/schedule an appointment with. Most PCPs will prescribe the common anti-depressants rather than referring you to a psychiatrist if that's what you want. 10 years ago, when I first moved to the state I'm living in now, I'm pretty sure my first contact with my PCP was to address depression and suicidal thoughts.
posted by drlith at 7:14 PM on April 9, 2013
posted by drlith at 7:14 PM on April 9, 2013
Remember that the undergrads use that facility and their parents have all sorts of insurance.
At the universities I'm familiar with, undergrads pay a separate fee for access for campus health services. The fact that undergrads can go there is not a guarantee that they accept the faculty insurance plan.
Your best bet is to go to the insurance website and searching for a pcp on their site. You can also call them to double check if a particular provider is in-network. Whenever I've called my insurance checking to see if a provider is in-network has been a menu choice, so it hasn't been too painful to call and the insurance company would rather you stay in-network so they're usually pretty helpful. If student health services is more convenient for you, you could try calling and seeing if a) they take your insurance (as k8t says, they probably do) and b) they will see you even though you're not a student (iffier).
posted by matildatakesovertheworld at 7:48 PM on April 9, 2013
At the universities I'm familiar with, undergrads pay a separate fee for access for campus health services. The fact that undergrads can go there is not a guarantee that they accept the faculty insurance plan.
Your best bet is to go to the insurance website and searching for a pcp on their site. You can also call them to double check if a particular provider is in-network. Whenever I've called my insurance checking to see if a provider is in-network has been a menu choice, so it hasn't been too painful to call and the insurance company would rather you stay in-network so they're usually pretty helpful. If student health services is more convenient for you, you could try calling and seeing if a) they take your insurance (as k8t says, they probably do) and b) they will see you even though you're not a student (iffier).
posted by matildatakesovertheworld at 7:48 PM on April 9, 2013
If I were in your situation, I would try two things before just randomly picking a PCP off a list of in-network providers. One is to contact student health services, and the other is to contact counseling and psychological services. In both cases, I would present myself as a grad student (not faculty...my understanding from your question is that you're still registered as a student right?) who is mystified and needs guidance, and ask if there is anyone who can talk you through your options. This might not really go anywhere, but if it does it could be a good way to get someone to help hold your hand through figuring this out.
posted by ootandaboot at 7:55 PM on April 9, 2013
posted by ootandaboot at 7:55 PM on April 9, 2013
ugh, I missed the part where you're still a student. Ignore my advice and call student health services first. Just say that you're unsure if you're eligible since you're technically both a student and faculty. They should be able to tell you if you're covered for treatment there. Note that you might be covered just by virtue of being a student (do you(r department) pay a campus health fee?), not your insurance, but student health services should be able to explain the situation regardless.
posted by matildatakesovertheworld at 8:27 PM on April 9, 2013
posted by matildatakesovertheworld at 8:27 PM on April 9, 2013
Just get a Primary Care Physician, they can and will write scrips for anti-depressants until the cows come home.
You should have a PCP and you should get a physical from your doctor annually so that they can rule out any medical issues before prescribing something.
I get my anti-anxiety drugs from my PCP and he's wonderful. He takes a holistic approach and we discuss everything about the drugs. It helps that he has Aspergers and is also a pharmacist/MD. He LOVES to talk about drugs and we have very intelligent conversations on the subject.
If you go to Emory, memail me and I'll give you his name.
posted by Ruthless Bunny at 6:16 AM on April 10, 2013
You should have a PCP and you should get a physical from your doctor annually so that they can rule out any medical issues before prescribing something.
I get my anti-anxiety drugs from my PCP and he's wonderful. He takes a holistic approach and we discuss everything about the drugs. It helps that he has Aspergers and is also a pharmacist/MD. He LOVES to talk about drugs and we have very intelligent conversations on the subject.
If you go to Emory, memail me and I'll give you his name.
posted by Ruthless Bunny at 6:16 AM on April 10, 2013
Pretty much any general practice or family doctor can and will prescribe a reasonably appropriate SSRI. It gets a bit trickier if you have a poor reaction, but for starters, find a group practice that is accepting new patients, and make an appointment.
posted by theora55 at 10:50 AM on April 10, 2013
posted by theora55 at 10:50 AM on April 10, 2013
This thread is closed to new comments.
Remember that the undergrads use that facility and their parents have all sorts of insurance.
So go to the insurance Web page, search for providers, and go in. It is fairly likely they'll hook you up with an antidepressant fairly easily.
posted by k8t at 7:02 PM on April 9, 2013